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CARRANZA’'S Clinical PERIODONTOLOGY NINT# EWITION CARRANZA’S Clinical PERIODONTOLOGY CARRANZA’S Clinical PERIODONTOLOGY NINTH EDITION Michael G. Newman, bos Adjunct Professor, Section of Periodontics School of Dentistey, University of California, Los Angeles, Los Angeles, California Henry H. Takei, ps, vis Clinical Professor, Section of Periodontics Seti ot Deitisiy, University of California, los Angsles Los Angeles, Caforia Fermin A. Carranza, Dr odont Professor Emeritus, Section of Periodontics School of Dentistry, University of California, Los Angeles Loy Angeles, California WB. SAUNDERS COMPANY Thdipta Londen NewYork Souls Syney Toronto W.B. SAUNDERS COMPANY ‘An tonprint of tsevier Science Livery of Corgness Caraging-in Publication Data CCarranaas Cine pecestontotagy. 94h ec) (euited hy} Meet Gi, Newarasy, Henry Takes, Feemin A, Cana, pee, Rev. Clinical peri Newman, Sth ef, B98, Includes bibliographical seerences ar inde IBN 2168980 2 GK. pages T-Perndonties. 1 Tite: Clinical periodonology. Ul. Newman, Michael GU Takei, Honey H, 19881 Carearaa Fermin tology? feted by| etenin A, Cartan, Ha Miche! INLET Pereslontal Diseases, 2, Oral Surya Provedires. 3, Pestana Prenthesis WU 210641 2402] RK G38 2002 LA S2 kt anorosa Soe hs et Dey Rep vasa Hot Jab Pee Kins A 1 Manage: Lina WeKsy Tr hen Fost Das Jasin “eARRANZAY CLINIC, *TRIODONTOLOGY ans nerztenaT sc that the se fof! pha pus 8.10 pe pages pak esl othe saa Associate Editors Sascha A. Jovanovic, DDS, MS IM. John Novak, BDS, LDS, MS, PhD Research Associate anid Director of Peceptorship Studies, rotessor, Departinent of Peikontic: Associate Division of Ora tology and Maslcine. Schon of Director, Certer for Osa Heth Research, University 0 Dentistry, University of California, Los Angeles, Los Kent ay, Levinton, Kents hy angeles California Susan Kinder Haake, DMD, MdentSc, PhD Asoc ssor, Section of Periodontics, Division Associa Clincal Specalites, Scho! of Dentistry Universi of Caltonnis, Los Angeles, Las Angele, alters Contributors AMfredo Aguirre, DDS, MS Diretor, Advared Oral and Masilloracal Pathology; Asouate Prater, Department of Oval Diagnostic Sciences, tate Uuiversiey of New Yori a; Bulfalo School of Duatal Mevicin Buttle, New Vork Wiliam F. Ammons, Jr, DDS, MSD Trnfewor Emeritus, Depaciment of Periodontics, University of Washington Schoo’ of Dentist, Seattle, Washington Samuel. Arbes, jr, DDS, MPH, PhD Clinkol Fees, Center sor Oral andl Ssatemie Diseases LUivesty of Nosth Carina Schoo! of Dentistry, Chapel iN, North Care ina Robert R, Azzi, DDS Cinieal Assneate Professor, Departinet of Peradonties, University of aris VT School of Dentist Private Practice, Pai, France James D. Beck, PhO Kean Profese, Hepartment of Dental boology, Unversity of North Carolia Sool of Dentistry, Chapel Hi, Neath Canslinw George W. Bernard, DDS, PhD Hhotssou, Department of Neurobiology, School of Danny, University of California, Low Angeles, Los angles, California John Beumer, Il, DDS Chaiman, Department of Advanced Prosthodontics, Momateria, and Hospital Denvistry, School of Dentistry University of California Las Angeles, Los Angels, Calton Carol A. Bibb, PRO, DDS Adjunct Professor, Section of Oral Medline and Druaaal ain, Seton) of Dentistry, University of California, Los Anges, Los Angeles, California, Jaime Bulkacz, Drodont, PhO Testun, Sect of Periodontics, School of Dentistry, University of Califomnia, Los Angeles, Los Angele, eaters Paulo M. Camargo, DDS, MS Assistant Prolesoe, Department of Periodontics, Division Associated Chinical Specialties, School 0 Dentistry, University of Cakforni, Las Angels, Las gel, (Ctomia Ting Ling Chang, DDS Achunct Assistant Profssoe, Department of Advanced Prosthodontics, Bhomaterals, ant Hospial Dentistry, Sctool of Dentists; Lndversity of Cattornta, Los Angles, Los Angeles Calfornia Sebastian G. Ciancio, DDS, PhD Distinguished Service Progessor andl Chay, Oxpartment bf Periodonties, State University of New York at Bulla School of Deri Netcne, Butta, New Vor Joseph P. Cooney, BDS, MS Chall Profesor ded Dicector, Department of Advanced sthodonties, School of Dentistry, nh California, Los Angeles, Los Angels, Callforaia, Denise J Fedele, DMD, MS {Clinical Associate Protessox, Department of Oral Health {Gare Delivery, Baltimore Collegeof Dental Surgery Dental School, Unwersiy of Marvlane at Kalmore Baltimore, Maryland: Chief, Professional Development «aud Research, Dental Care Clinical Ceates, Veterans Aciministation Maryland Healtheare System, Petty Point, Maryland Thomas F. Hemmig, Dr, med. dent, Professor CChaliman, Clinic of Periodontology, Westlian Wilhelm University, Muster, Geauany Stephen F. Goodman, BA, DDS Former Clinical Pofessoy, Livision of Pesedontics, Columbia Univesity Scheol of Dental and Cal Surgers New York, New Yorks Past Present, American Academy ‘of Peslodontology; Diplomate, American Board of Pestodontology ‘Susan Kinder Haake, DMD, MDentSc, PhD Associate Profesor, Section of Periontontis, Divison of Associated Clinical Specialties, Seo! nt Dentist University of California, Ls Angeles, Los Angeles, California ‘Thomas |. Han, ODS, MS Adjunct Associate Professor, Department of Periodontics Section of Periodontics, Setivol of Denti, University ‘of California, Los Angetes, fos Angeles, Cal fornia Gerald W. Harrington, DDS, MSD Protessr Emeritus, Department of Eredontics, University of Wastington School of Dentistry, Seattle, Washington James E. Hinrichs, DDS, MS. Assoviate Professor atx Direstor, Advance duction Progvamt in Pesiodor tology, Department of Preventive Sciences, University of Minnesota School ot Dentist Nhinneapolis Minnesota Eva L. Hogan, MD, DDS, MS Lectute, Section of Periodontics, Sehool of Dentsty University of California, Los Angeles, Lat Angels, California {George T. Huang, DDS, MSD, DSc ae Programs Pirector and Acsistant Prokesou Secon nf Erdedontic, Division of Associated Cinkcal Speciaites, Shoal of Dentistry; Univesity of Callorai, los Anges, Los Angeles, Catone Maria E, toiz, DrOdont Pater and Chait, Department of Oral Pathology Faculty of Dentists, University of Buenos Aires, Rueos Aes, Argentina David Jolkovsky, DMD, MS, Aabunct Assistant Professor, Soetion of Periodontics, Scthol of Dentsty, Universi of Califor, Los Angeles Las Angels, Californias Duval Pzatice, Davis Caltornia Sascha A. Jovanovie, DDS, MS Reseaseh Associate and Director of Pecepleesiup Stas, Disiiou of Oral Biology of Medicine, Scho! a Dectishy, Univesity oF Caltormia, Loy Angeles, Asal, Calforva; Present, Furppean Assocation “or Osseointegtaton, Fone, England E.Rarrie Kenney, BDSc, DDS, MS, FRACDS ‘Ghai of Division of Assoctated Clinical Speciaiies and erhasotics, Seo of Dentistry, University of Calor, Los Angeles, Les Angeles, Calornt erty R. Klokkevold, DDS, MS saw: Profesnor and Clinical Director, Section of Periodontics, Scio! of Dentistry, University of Calfornia, Los Angeles, le Angles, California Vincent G. Kokich, ODS, MSD Fratesor, hepertment of Orthodontics, University of ‘anningon Scion of Pentisiy, Seat, Washington Pamela K, McClain, DDS (Conical Assistant Prolesor, Deparuaeat of Surgical Dentistry, aversty of Colona School of Dentist, ere, Coral; Resear Protessr, Departenent ot Denia, University of Masylan Dental Seno saliesnve, Maryland ‘Michael J. McDevitt, DDS Visiting Ficuity, The Pankey lnstitute for Advance Dental lahwation, Key Biscayne Florida; Private Prati, Ante, Gees brian L. Mealey, DDS, MS Chatman anal Program Dicctor, Department of Feeeadonticy, Who Hall Medical Center, Lackland Air owe fe, esas Clinical Asta Pots Department of Periodontics, University af Texas Het Soienee Conte, San Antonio, Texts Robert L. Merin, DDS Privase Practice, Worlland His, Calvioraka: Dipiowsae ‘merican Hoard of Pesodantology Bryan 5. Michalowicz, DOS Associate Professor, partment of eeventive Sciences University nf Minnesota Setioe ot Denti Mir Kenneth T, Miyasakl, DDS, Pho Asyoviate Profesor, Department of Oral ate nt Dentists, University of Califor, 10s Ang Ange'es, Caroma Richard J. Nagy, DDS lactuter, Department of Peeiodontis, School o Dontistry, Uniserty of California, Las Ages, Los Angels, California; Staff eviodonist, Greater Los Angeles Veterans Admiinistathon Healthcare Ssster, oy Angeles, Caloris Jan Needleman, 8DS, MSc, PRD, MRD, RCS (Eng) Pops nt of Petiodontology: Fastin Dental Insite tonsa Heal €ate Sclences, Univer Landon Tuk, Eland Mirdza €, Neiders, DDS rateson, Deparment of Oral Digguostic Slentes, State Univesity of New Sork at Bulla Stool of eta Meatcing, ffat, News York Linda C. Niessen, DMD, MPH, MPP Clinical Professe, Department of Publi Health Seicces, Iuayler College of Dentistry, exas ASM Health Sciences ener, Dallas, fxs, Vie President of Clinical eucation, Dentspy lnternational, York, Penrsytvans Russell J. Nisengard, DDS, PhO Dike guise Teaching Prokssor and Associate Dear far Advanced Hsucation and Research, Departments 0 nlontics und Linodontics, Slate University of New at Butalo Sehiootof Dental Meh, Baral, New seh es, Los Karen f, Novak, DDS, MS, PhD Associate Professor, Department of Periodontics, Center or ral Health Reveal, University of Rentues Lexington, Kemtucky IM, John Novak, BDS, LDS, MS, PhO. Protest, Depatiment of Reiodonticy, Associate Dinecter, Centet for Oral Health Research, Univesity of Kentucky; Lexington, Kentucky Joan Otomo-Corgel, DDS, MPH Chair of Research, Department of Periodontics, Greeter os Angeles Veterans Administration Healthcare system ros Angeles, California; Adjunct Assistant Professor it iesicerne, Departenent of Periodontics, Schoo ef Dentistry, University of Caitornia, Los Angeles, Los svngeles, Clitoris Kvang-Bum Park, DDS, MS, PhO \Wivling Assistant Rescarhct in etodonties, Seto) of Deulisiry, University of Caitorna, ls Anges, Las saigeles, Calonia: Ditector,Perioane Insitute (Clinica! Penocontiesand Implantology, Taegt, Bu Lectures in Oral Anatomy and Histology, Kyl awk National University, Taegu, Korea Anna Pattison, RDH, MS |woelate Professor, Department of Dental yg Schoo. of Deutistey, University of Souther Calta las Angeles, Foy Angeles, Calton Gordon Pattison, DDS Lecturer in Jersndonticy, Seta of Dentistry, tensity ‘of Calilorni, as Angels, Les Argos, Ca uni Dorothy A. Perry, RDH, PhD Vice Chai, Department of Preventive and Restorative Dental Selences: Chal, Diss of Dental Hygiene Uanersity of Calfornia-Sar Feaneisco School af Dentistry, So Francisco, Catorna Gregor Petersika, Dr. med. dent Awistont tofeayor, Clinic of Periodontol ‘Wilhelm University, Munster, Guerin Bruce |. Pihstrom, DDS, MS Fin Shae Pritt Reseach Peotese, Dygutiment of Preventive Scknies an Pertodentology Univesity of Minnesota School of Dentistry, Mincaps, Mines John W. Rapley, DDS, MS Dyetor,Grahiste Ueriolontis and Chater, Departs ot Peviadonties, University oF Masih" Karous ity Selon oo Dentistry, Kansas City Mist Terry D. Rees, DDS, MSD Chara and Professor, Deparment of Peioconties, Taylor Collegeof Dentistry, Teas ASM Hea Sefences (Canter, Dab, seas Een Roumanas, DDS Clinical serie Presson, Department of Advanced Prosihedoeies,fkamaterlals rl Hospita! Dentstey Schon ur Density, University a Calton, Les Angeles, Las Arles, Califor Mariano Sanz, MD, DDS, PhD Profs, 128 ad de Oxlontolowa, Univecsad Chmptense Ala, Meal, Spain Robert G. Schallhorn, DDS, MS Clinical Profs, Department ofS Colorad Maseaich Pretec, Departaent of Periodontics, Baitimore Colleye of Dental Surgery Dental School, Un ceisty oF Marvlane at faltmore, anor, Maryland Max 0. Schmid Former Asackte olessor of Pevialontes, Sli of Dentisty Univesity of Calllorai, Los Ante, Lis soles, Caverns; Hate practice, Aatau, Soceiand Dennis A, Shanelec, ODS Director, Miceusurgery Traits Institute, Santo Barta California Gerald Shklar, DDS, MS (Charles A. Bast Professor of Oral Patho University School of Dental Medicine, Boston Massachustts Thomas N. Sims, DDS Seaior Lecture: Departament of feriadontes, Schon of Dentisirs, Ualversty af Caltouna, Las Angels, Los Anges, Calla Frank M. Spear, DDS, MSD. AMiliate Peotessor, (iraduate Prosthodontics, Unversity fof Washington Subool of Desisty, Seale, Washington resent leet, American Aciéemy of Esthetic Dentistry Leonard S, Tibbetts, DOS, MSD Visiting Asci:znt Protesny, Graduate Perodonties, Lniversity of Wastington Sehiolof Dentists, Seat Washingtor Albour THE AUTHORS Die Mktg! G. Newmar foo the Uiversty of caorna=Los, Drache Collegeof ters aS ces at degece mn Psychos. He Completed his devtal taining at the School of Detnisry, University af C3 shy: Since tha time, fe as pase Ione tn 250 antiats, josa at le a ook apes a x sel ever cesthows, Tit Nema fay servi a an al tc neice? or NIDCH, consultant to the cour Dental Assicction, stat ever or Diplomate of the Ameria: Haas ot a wey ond a Aahunct Fess of Peiodniks a the Se Dentistry, Unversity of calfora The Newnan fs fovtsted thao to Argles, De Newian ie a Fell nat the worlé on mica, ain ana post Prevent of The Am er bed neti hk acters, ar ig —— te 1br Newman tuce-ved a Cercate in fercaamtics anal carapumnes thought tae wel (onal Medicine athe Hara Schoo! of Dental Meine De Nevwian fhe Elterit-C il a Cercle i Oval Mictobsogy a tae Post Okt i. Sigurd Soxran Henry H. take BS, M8, PACD. Deets He takel graduated from the Miargueite Lsivesity Sell of Bent tity in 1965, the complete his Petladonties Cette and Master of Scene Deguee tn 1967 at Marquette University ann tae Veterans liinistration Hos pital in Winconsin, Dr. Takel iy Clinic Profssar of Pesaontics a the Se University of California, Lar Angeles, Coa of Dentistry mn Tpit a Los Angeles, ac las pate prstice Time to pestodonscs and pint suery Dr. Takei has purdishad numero aii om petal gery’ ane has contibated chapters to five textbooks. He has ceived many eating aware, fro both anor Dr, Ts Tis ec th anu theraps epmin A. Carranza, DeCdont, EACD Dr. Fermin A. Catrtia graduated trom the: University of Buenos Aites Seta ‘of Dentistry in Argentina in 948 aed completed his postdectena teas Periodontics al Tals University Seve! af Dental Meuiine te 1952 une: the snentorship of, lving Glickman, De Carina fy Proksor Emettus of Peredontotugy athe Schoo! of Der istry, University 0 Califonala, Longe, He was Head vb the Departsien fy Perndontcs a the Univers of Buenos Ales Fawn 1966 ko 1974 aad at University of California-Los Angeles fm 1974 uni his tleeten in 1994 Dr. Catranzs has publishes! moe than 218 seieniie papors ask! absleats fn basic andl applied aspects of periolantics and eight boss, ictus, the list four editions of Clea! Peay. He tus sev snes ads ristontology il jill ye originator of this eck and anthor ots fist toa eitions, published in 1953, 1958, 1964, snd 1972, as Dr laving Glickman, essor ahd Choimiar «the Departmen of Periodontology at Tuts University Sela! of Dental Mics, fn Dh. Glckmie wi a prominent esearch, sped teas ile speaker, ad bulant wter whose co {apis shapks peiedontal thinking for many years. His yke ar writing and: many of hs onigina Uustations, iikis, anal philosophy of deetal practice ean SUN be foun in many ateas of this book. ‘er Dr. Glickrmae’s dst i 1872 at §8 years of age, the responsi for contin hs Bok was passe De fermi A Caman anee a sent ane colar fr ick. Ae the time Dx, Cantanea was Profesor fund Chakeman of Periodontics at he Sehoal af Dentistry Uniersity of Calfornia-Law Angels (UCT). The tol Jong fo punts in 1979, 19M, 1990, and 18% under the gukdanee « Dr Cortana, sso ny Pofessor Emeritus at UCLA. For this present cation, the task of taratatning the book's sraticey of anont hale + centoay has enanged lands onee again. Dk. Michel G. Newman ane Di Hendy H, 1akeh have jane! Di, Carranza to take major cspunsibity “or ths nah edition, Tw the 49 yeats that have elapse since the fst ed tio ofthis bok, pecidantology as mad: tremendeas proxies, The analysis of pesextontal hncevanisms an causes thee nvolvenent in varios Pathog processes bas gone beyond. stology and Dvsieay fae eelltar and male research, Thea Petite goats and techni, bused on the bmproxed hice Ingle foundation an! maple techno wgie advances, have sree he gral of allan peronkotal eat ant ahsquate function. Today, seconsteuction lost Strucunes, rephicemere of teeth by implants, and Detwument or etete results are intel pts el ‘al peridot 11 chis develomerst and gow has ested in rev sions cf acitions to, andl mocifvations 49 the book's Preface Can nd enanication throughout this st Ths muftaetel compe ak he soe the talon of merous expe in he vacous lds hat tur Gisedpine has entered This elon hae als Benched ya unui of teh colo eitorl advances tat not ly mises the book tots aac but asa help feng ans san Ing text and gues, The akon ol a C)-OM soe ing susstions thet may ep teachers ay sens ad deincened ize of sit fr cic char til greatly enhance te selnness the bok. THe HOM I 9 wonderul coon of istalans, ase ut ies complex aga! proses implants, Maley og adel pholgraphis. The CD-ROM sie sor temute can be ase to create your perso cll tng or to develop» peeeton for your sdene oe colleagues, a Ths uk comlindes,oeve, tobe rtmariy atx bord or activins of general eat 4 tales preparing to become general practioneh, Ie contains Soil ht the pe iexoital cate ol the public ts primarily the concern of the geneal dentist, wha cannot cared 5 oF het Fe sporbilty to examine, trea, os geet all peelocontal probes. the high incidence of peslodaal problems fnd tne close relationship bersten periodontal ad estate dea theres makes 1a an ineosteower ie point, A wollte! yroup of perksontists who Specialize fo the daygon's anu trearment of severe ar ‘al peony Ik! serve to supplerser the gett Senta eare aval able tocar poptlatkin, is aur hope tha cis new eter sil Cantina 10 hae ty une dentists, periodontist, are sens as the peevious editions ad that fell eontebure ti the comin progses of oc press Mictnacl G, Newman Henry Hi. taked Fermin Ao Carran